Integrative Medicine at SCCA - Fred Hutch...Why Integrative Medicine at SCCA? Integrative medicine...
Transcript of Integrative Medicine at SCCA - Fred Hutch...Why Integrative Medicine at SCCA? Integrative medicine...
Integrative Medicine at SCCA: A New Program for Survivors
Heather Greenlee, ND, PhD
Medical Director, Integrative Medicine Program Associate Member, Fred Hutch
Associate Professor, UW School of Medicine
June 2, 2018
Why Integrative Medicine at SCCA?
Integrative medicine can support patients during and after conventional treatment, throughout survivorship
Many patients are using complementary and alternative therapies, often uncoordinated with conventional care
Need for a truly integrated clinical practice model
Growing body of evidence on the use of integrative therapies to manage symptoms, decrease side effects and improve quality of life
Need for patient education on what works and what is safe
Definitions
Traditional therapies Culturally-based health practices
Alternative therapies Used in place of conventional medicine
Complementary therapies Used with conventional medicine
Integrative medicine Evidence-based use of complementary and supportive
therapies in conjunction with conventional therapies
National Center for Complementary and Integrative Health nccih.nih.gov
What is Integrative Oncology?
Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments.
Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer continuum and to empower people to prevent cancer and become active participants before, during and beyond cancer treatment.
Society for Integrative Oncology, 2017
https://integrativeonc.org/integrative-oncology-guidelines
Recommended Therapies
High certainty that the net benefit is substantial or moderate to substantial
Anxiety / Stress
Meditation
Yoga
Stress Management
Music Therapy
Depression / Mood
Meditation
Relaxation
Massage
Music Therapy
Yoga
Chemotherapy Induced Nausea
& Vomiting
Acupuncture
Electro-acupuncture
Quality of Life
Meditation
Yoga
Greenlee et al, CA Cancer J Clin, 2017
Therapies to Consider
At least moderate certainty that the net benefit is small
Anxiety / Stress
Acupuncture
Massage
Relaxation
Depression / Mood
Acupuncture
Healing Touch
Stress Management
Chemotherapy Induced Nausea
& Vomiting
Ginger
Relaxation
Quality of Life
Acupuncture
SubQ Mistletoe
Qigong
Reflexology
Stress Management
Greenlee et al, CA Cancer J Clin, 2017
Therapies to Consider
At least moderate certainty that the net benefit is small
Fatigue
Acupuncture
Yoga
American Ginseng
Hypnosis
Pain
Acupuncture
Massage
Healing Touch
Music Therapy
Hypnosis
Sleep
Gentle Yoga
Lymphedema
Laser Therapy
Manual Lymphatic Drainage
Greenlee et al, CA Cancer J Clin, 2017
Therapies with No Benefit or Harm
Not recommended due to no benefit or harm
Fatigue
Acetyl-L-Carnitine
Guarana
Hot Flashes
Soy
Acute Radiation Skin Reaction
Aloe Vera
Hyaluronic Acid Cream
Chemotherapy Induced Nausea
& Vomiting
Glutamine
Neuropathy
Acetyl-L-Carnitine
Greenlee et al, CA Cancer J Clin, 2017
Integrative Medicine Program at SCCA
Patient
Mind-body Medicine
Acupuncture
Massage Therapy
Therapeutic Yoga
Naturopathic Medicine
Interdisciplinary Supportive Care at SCCA
Patient
Integrative Medicine
Pain
Palliative Care
Psychiatry
Social Work
Chaplaincy
Physical Therapy
Nutrition
Integrative Medicine: Program Framework
Services focus on symptom management and quality of life: pain, fatigue, anxiety/depression, stress, nausea, sleep, lymphedema, neuropathy, diet, physical activity
Referrals are welcome at any point along treatment and survivorship pathway, and patients can self-refer
Resource for patients, families, clinicians and SCCA staff with an educational focus
Provides platform for novel patient-centered research
Integrative Medicine Nurse Practitioner
Kathleen Sanders, ARNP-board certified, MPH Training
Board certified in Family Medicine Fellowship in Integrative Medicine Mindfulness Based Stress Reduction Training Mindfulness Based Eating Awareness Guided imagery Clinical Hypnosis Auricular Acupuncture
Clinical Focus Evaluate & guide an evidence-informed integrative medicine care plan Mind-body medicine Safe and appropriate use of dietary supplements Evaluate & guide dietary recommendations, in conjunction with
Nutrition Services
Naturopathic Physician
Heather Greenlee, ND, PhD, MPH Training & Leadership
Board certified in Naturopathic Medicine, Bastyr Univ Acupuncture & Traditional Chinese Medicine Past President, Society for Integrative Oncology Member, Academic Consortium for Integrative Medicine & Health NIH-funded research portfolio on integrative health since 2001
Clinical Focus Evaluate & guide an evidence-informed integrative medicine care plan Safe and appropriate use of dietary supplements Practical implementation of national recommendations for diet, physical
activity and weight management for cancer survivors
Acupuncturist
Jonathan Siman, MS, LAc Training
Board Certified Diplomate of Oriental Medicine: Acupuncture/Herbs Washington State Licensed Acupuncturist Previously, Memorial Sloan Kettering Cancer Center acupuncturist Candidate, Doctor of Acupuncture and Chinese Medicine (Fall 2018)
Clinical Focus Mitigating side effects associated with chemotherapy, radiation and
surgery Focus on nausea, pain, hot flashes, neuropathy, mouth sores, insomnia Improving quality of life during all stages of cancer care and survivorship
Massage / Therapeutic Yoga
Larra Dutton, LMT, CLT, RYT Training
Board Certified Licensed Massage Therapist Oncology Massage Training Registered Yoga Teacher Certified Lymphedema Therapist Lymphofascial Scar Training
Clinical Focus: Relaxation, stress reduction, insomnia, depression, fatigue, pain, and
motion restriction due to surgical scaring
Evidence Based Lifestyle Changes
Guided by letting go of perfectionism and being kind and compassionate with ourselves
Being Your Healthiest
Self
Mind-body Medicine
Exercise & Movement
Sleep Natural
Products & Supplements
Food as Medicine
Our Research: Acupuncture Trial
Early Stage Breast Cancer Survivors (n=226)
Acupuncture for reducing Aromatase Inhibitor- induced joint pain
Patients were assigned to true acupuncture, sham acupuncture or waitlist control group for 12 weeks
Results: Patients who received true acupuncture had less pain up to 24 weeks
PI: D Hershman, Funded by NCI & NCCIH
Take Home Message: Acupuncture can curb treatment-related joint pain in breast cancer survivors
Lifestyle Guidelines for Cancer Survivors
1. Eat a plant-based diet 5-9 servings fruits/veg per day
Eat whole grains
Limit energy dense foods
Limit red meat
Limit alcohol
2. Engage in daily physical activity
30-60 min moderate-to-vigorous per day
3. Maintain a healthy body weight
BMI 18.5-24.9 kg/m2
Our Research: Cook For Your Health! Trial
Latina Breast Cancer Survivors (n=70)
3-month Intervention
4 Nutrition Classes
3 Cooking Classes
2 Food shopping field trips
Results: Increase in fruits & vegetables intake; and reduction in total calories and fat intake after 12-months
www.cookforyourlife.com
Take Home Message: Nutrition education, hands-on cooking and shopping classes can lead to sustainable dietary change
PI: H Greenlee, Funded by NCI
Our Research: My Healthy Life! Trial
Latina Breast Cancer Survivors (n=200)
12-month Intervention (on-going)
Culturally tailored education
Hands-on culinary skill building
Food shopping education
Hands-on physical activity
Motivational text / email messaging
Outcomes:
Changes in diet and physical activity
PI: H Greenlee, Funded by NCI
Summary
SCCA has a new Integrative Medicine program
A body of evidence supports the routine use of selected integrative modalities in the oncology setting
Clinical guidelines improve the ability for patients and clinicians to make informed healthcare decisions
To learn more about our program at SCCA:
THANK YOU!